The advent of electronic health records (EHR) systems was built on a foundation of improving patient care. Establishing infrastructures that support highly accurate patient data, closing gaps in communication between healthcare providers, and securely storing records are all among the goals of a certified EHR system. To standardize this, certified EHR systems were conceived and built.

Why is Certified EHR Technology Necessary?

Certified EHR technology is simply a method of taking the ideas of improving patient outcomes through technology forward in a standardized, regulated fashion.

But what does this mean for providers?

Not only does adopting a certified EHR system ensure that your records adhere to requirements for HIPAA and Meaningful Use through CMS and the ONC, but they also can qualify medical practices for federal incentive programs, which can greatly reduce the cost of EHR implementation.

Who Certifies EHR Technology?

The requirements for certified EHR technology are generated and regulated by the federal government. Both the Centers for Medicare & Medicaid Services (CMS) as well as the Office of the National Coordinator for Health Information Technology (ONC) determine the regulatory requirements for certified EHR systems.

Overview of Requirements

In order to adhere to Medicare and Medicaid requirements (and to qualify for incentive programs), an EHR system must meet a set of requirements, and then further, a medical practice or organization must put those features appropriately to use. Meaningful Use was broken down into three stages, and while details on all the requirements for the three stages can be found here, below is a brief overview of requirements to demonstrate Meaningful Use.

• Data capture and sharing

Stage 1 of Meaningful Use focuses on essentially capturing and tracking KPIs (key performance indicators) within a clinical setting. Coordinating care with this new information includes both in-office communication, and communication with patients and their families.

• Advance clinical processes

Stage 2, advance clinical processes, focuses on honing electronic processes such as e-prescriptions, online laboratory reports, electronic delivery of patient care summaries such as after visit reports, and a new focus on Health Information Exchange (HIE).

Electronic health records (EHRs) have been adopted by thousands of hospitals. HealthIT.gov reported that nine out of 10 of all eligible hospitals achieved meaningful use through December 2014.

Once hospital staff members and physicians became accustomed to EHR technology, they and their patients reaped the many benefits offered by switching from paper to digital health records, including:

Patient information being more complete.

Diagnoses being more accurate.

Better data, leading to quicker and safer decision-making.

More convenience for patients with shorter wait times.

Integrated data improving the coordination of care.

Greater efficiencies leading to significant cost savings.

Fewer medical and medication errors.

Improved patient outcomes.

The cost savings and convenience delivered through EHRs are certainly valuable, but their positive contributions to patient care are even more noteworthy.

Predicting Mortality Rates Studies show that EHR use yields significant clinical benefits. In one study conducted from 2010 through 2012, HIMSS Analytics and Healthgrades found that hospitals using advanced EHRs were better at predicting mortality rates.

Researchers studied 32 different procedures across 4,500 acute-care facilities, and evaluated the associated mortality rate. They then examined the hospitals’ EHR use, and concluded that those using more advanced EHRs were better able to predict mortality rates for most conditions, including stroke, heart attack, COPD, pneumonia, respiratory failure, and stomach and intestinal surgery.

Positive Clinical Outcomes Through the HIMSS study, researchers also found that hospitals with advanced EHRs captured more patient information. And perhaps most interestingly, the mortality rates of the advanced-EHR hospitals actually improved for heart attack, small intestine surgery and respiratory failure.

How could EHRs lead to positive clinical outcomes? With improved data capture, physicians can better monitor additional patient risk factors, base their decisions on more complete information and manage patient care more effectively.

Healthcare professionals across the country are documenting lives saved thorough EHRs, particularly due to the universal anytime, anywhere access to a patient’s health record.

It’s clear that building improved care models and eliminating errors through missing, delayed or incomplete paper records have been a game-changing outcome of EHR use.

Increased Patient Satisfaction Although physicians may not always communicate to patients the many benefits they can experience with EHRs, they have proven to be significant:

Efficiency is probably the most noticeable advantage, which becomes clear when patients are awaiting test results or diagnoses. Primary care physicians and specialists no longer need to contact each to obtain important information, or wait for a lab to send test results; lab results are now sent electronically to healthcare providers, and often directly to patients, as well.

Convenience is achieved through quicker appointment setting, as well as shorter office wait times as result of improved pre-visit communication.

Health improvements stem from more frequent reminders of important preventative measures, such as diabetes and cancer screenings.

Patient engagement often improves, especially when doctors use EHRs to educate patients about their health.

Increased time spent with the physician, as a result of reducing the time spent searching for charts or tracking down patient information.

When patients feel their time is respected, and understand the status of their health, they are more satisfied with the care they receive.

Successful EHR Implementation Yields Important Results What is more important in healthcare than saving lives? By leveraging the power of EHRs, healthcare providers have the potential to continuously improve patient outcomes and decrease mortality rates, while improving the physician-patient relationship.

Implementing advanced EHRs equals a win for those on both sides of the screen.

In an effort to increase the use of electronic health records by doctors, hospitals, and other health care providers, Congress passed the Health Information Technology for Economic and Clinical Health Act, more often known as the HITECH Act, in 2009. The law provided both incentives and penalties to encourage widespread adoption, but so far many hospitals and doctors have failed to comply.

On December 17, 2014, the Centers for Medicare and Medicaid Services (CMS) announced 257,000 doctors had failed to achieve what it termed “meaningful use” of electronic health records, and would have payments for Medicare services reduced by 1 percent as of January 1, 2015.

According to the American Medical Association, that is more than half of all doctors covered under the HITECH act.

“Doctors struggle because the user interfaces are slow and there are too many questions,” Bentivegna said. “It works poorly with ophthalmology, my profession.”

Incentives and Penalties

Early on the HITECH act provided taxpayer funds to medical providers to help pay for the adoption of electronic health records. Those incentives will remain through 2016, but penalties have also kicked in for those who haven’t satisfied the CMS meaningful use requirement. The 1 percent reduction in 2015 will rise to 5 percent over five years, taking a significant bite out of many doctors’ revenue.

Dr. Stephen Stack, president-elect of the American Medical Association, expressed dismay over the news 257,000 doctors would be penalized in 2015.

“The Meaningful Use program was intended to increase physician use of technology to help improve care and efficiency,” Stack said in a statement. “Unfortunately, the strict set of one-size-fits-all requirements is failing physicians and their patients.”

Twila Brase, president of the Citizens’ Council for Health Freedom, sees the meaningful use requirements as a backdoor way for the government to play a heavier role in directly controlling medical care.

“So if you want to control the entire health care system, what do you need?” Brase asked rhetorically. “You need to know what the doctors are doing, you need to decide what you want them to be doing, and then you need a system to record how far they are removed from what you want them to be doing to that you can financially penalize them.”

Brase expressed concern the electronic health records created in compliance with the HITECH Act will be used to ration care, pointing to comments by controversial MIT economist Jonathan Gruber.

“Gruber says they only want people to get the right care for the right things,” Brase explained. “They’ll sometimes talk about ‘right place, right time, right patient, right care,’ as though we were all sort of widgets in the system. Their plan is to use all of our data to standardize the practice of medicine, to put those standardized treatment protocols on the electronic health system, and nothing else.”

Developments during the last week of January will have a serious effect on the progress of meaningful use, interoperability, and health reform in the coming year.

Perhaps the most important development for health IT was a reduction in meaningful use reporting requirements in 2015. After months of feedback criticizing the meaningful use requiring for reporting in 2015, the Centers for Medicare & Medicaid Services (CMS) finally decided to opt for a 90-day reporting period rather than one requiring a full year’s worth of EHR data.

In a CMS blog post, Patrick Conway, MD, the Deputy Administrator for Innovation & Quality and CMO, highlighted three meaningful use requirements the federal agency is considering for an upcoming proposed rule.

The first would require eligible hospitals like eligible professionals to report based on the calendar year, which would give these organizations time to implement 2014 Edition certified EHR technology (CEHRT). The second would change “other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.” Lastly and most importantly, CMS is considering reducing the meaningful use reporting requirement from 365 days to 90 days.

As Conway noted, this proposed rule is separate from the one for Stage 3 Meaningful Use expected next month. However, the spirit of the two proposals is to reduce burdens on providers while promoting expanded use of CEHRT.

Most recently, the Office of the National Coordinator for Health Information Technology provided its earliest plans for enabling nationwide interoperability. The first draft version of the interoperability is the first iteration of the federal agency’s long-term plans for enabling a health IT ecosystem and infrastructure with the ability to exchange patient health data efficiently and securely.

“To realize better care and the vision of a learning health system, we will work together across the public and private sectors to clearly define standards, motivate their use through clear incentives, and establish trust in the health IT ecosystem through defining the rules of engagement,” National Coordinator Karen DeSalvo, MD, MPH, MSc, said in a public statement.

The lengthy draft comprises both long- and near-term goals for promoting standards-based exchange among healthcare organizations and providers. The document is current open to public comment through the beginning of April.

At a higher level, the Department of Health & Human Services (HHS) laid out its plans for shifting healthcare dramatically from volume- to value-based care. Secretary Sylvia M. Burwell has committed Medicare to making half of the program’s reimbursements based on value by 2018. Over the next two years, the department is aiming to shift 30 percent of fee-for-service payments into quality-based reimbursement paid through accountable care organizations (ACOs) or bundled payments.

The challenge for the department and the Medicare program is significant considering that accountable care comprises an estimated 20 percent of total Medicare payments. “We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement,” Burwell said.

While all these changes took place within HHS, President Barack Obama and members of Congress began revealing their plans for supporting personalized medicine. The President’s Precision Medicine Initiative is already on the table and offers $215 million to support the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and ONC. Meanwhile, the House Committee on Energy & Commerce is moving forward with the discussion phase of its 21st Century Cures initiative which aims at speeding along patient-centered regulation and supporting medical researchers, clinical data sharing, clinical research, and product regulation.

All in all, the last week of the first month of 2015 may go down in history at a pivotal moment in the real transformation of healthcare in the United States.

A number of Epic Systems products have achieved top marks in the annual Best of KLAS health IT and EHR rankings, including best overall physician practice vendor and best overall software suite in addition to other awards for acute care, ambulatory care, health information exchange (HIE) and patient portals. The recognition signals a return to dominance for the health IT giant, which temporarily lost its top title to athenahealth in 2013.

“We are honored to be able to continue to work with talented healthcare providers to create the annual Best in KLAS report. Their feedback is beneficial as vendors strive for excellence,” said Adam Gale, CEO and president of KLAS Research in a news release announcing another winner, Phytel, which was named the top population heath management vendor. “We also look forward to expanding our global research initiative to evaluate additional products/services that impact both provider and vendor success.”

Other familiar names featured frequently in the latest report, including Impact Advisors, winner of the overall IT services firm category, Cerner Corporation for best small ambulatory EHR, and athenahealth for small and mid-sized practice management. Epic, however, snagged the ribbon for large ambulatory practice management.

Accenture Health may be getting a few more phone calls in the next few months after being named best ICD-10 consulting firm, while Optum’s computer assisted coding (CAC) expertise won the category for the in-demand technology. For clinical documentation improvement (CDI), another critical ICD-10 competency, KLAS awarded first prize to Navigant.

Overall, Epic received eleven recognitions from the independent research company, which indicates how deeply and widely the company has been able to integrate itself into the healthcare industry’s IT needs. In contrast, Cerner received three nods and athenahealth bagged two, while McKesson and MEDITECH had one apiece. Last year, athenahealth had five honors to its name, with Chairman and CEO Jonathan Bush claiming that his company’s victory over Epic for ultimate prize was a triumph of “nimble, innovative models” over the “old guard of HIT leaders.”

Putting aside Epic’s runaway dominance – and athenahealth’s slip from the spotlight this year – Bush may have been correct in saying that new contenders are challenging the big names that seemed so solidified in the early days of the EHR Incentive Programs. The large number and diversity of winners shows that the marketplace continues to be fragmented, giving new companies a chance to offer the intuitive, user-friendly, feature-rich EHRs that healthcare organizations are clambering for.

With EHR replacement still a very strong force in the marketplace, vendors have a strong incentive to claw their way past their competitors onto EHR ranking lists that give them visibility and credibility in an environment of weary mistrust.

“We are all part of a community of care,” Gale said of the 2013 winners list. “From the vendors that provide services and advance healthcare technology, to KLAS, who produces insights on vendor performance, to the providers who administer care, our joint efforts can make a difference in the lives of the patients.”

“To the healthcare providers, your effort to be heard and counted is critical. It is your voice, amplified by KLAS, that can drive improvements to healthcare technology and services. To the healthcare vendors who diligently seek to align with provider needs, we thank you for your unwavering determination to deliver excellence with passion. We commend your efforts to truly be Best in KLAS.”

Like many managers or owners of a thriving medical practice, you have heard about the benefits of using electronic health records software and are interested in implementing an EHR in your organization. You can assume that many, if not all, of your nearby competitors are using EHR, and the more effective they are in using this software, the better they will be able to attract and keep patients.

Transitioning from the old methods of paper-based systems to the latest advances in medical software is bound to raise some questions among you and your staff. Therefore, it’s a good idea to do some research first before making the commitment and selecting your EHR. With that in mind, here are some questions to ask as you prepare to make your choice.

Is the Software Vendor Knowledgeable and Reliable?

It’s much better to go with a software vendor that has sufficient experience, knowledge, and a proven track record in developing mission-critical software like EHR. Find a firm that has been around for a while and that has excellent reviews from your peers, as well as your competitors.

A software developer for medical organizations must have a staff that keeps up with the changing nature of healthcare delivery, adjustments in industry standards, and governmental rules. This ensures that you will always have access to software this is compliant with the entities you do business with.

What Kind of Training is Available?

After assessing the skill level and knowledge of your medical organization, you will have a better idea of how much training you need. Make sure that your software provider will give your team the training and help it needs to quickly get up to speed with using EHR software.

How Does the Software Company Handle Upgrades?

Upgrades are a fact of life in any computer system. You’ll want to ask your vendor how it approaches upgrades. There will be upgrades to improve the quality of the software, to be sure, but there will also be required updates, such as the ones EHR software developers must finalize to meet the U.S. government’s required change from ICD-9 to version 10 of the International Classification of Diseases.

Does the Software Vendor Provide Good Customer Service?

The last thing you want when dealing with unfamiliar software is to contend with unanswered questions on how to use it. Check the level of customer service from your prospective provider. Otherwise, your staff may experience unexpected and unnecessary downtime, hampering office productivity and lowering your organization’s financial success.

Making the decision to move from a paper-based system for managing your medical organization will make a significant impact on your staff’s daily activities. Now that you know you want to implement an EHR, it’s crucial to resolve any unanswered questions before making your software selection.

Key Takeaway:

Medical practice owners and managers who are aware of electronic health record software will want to ask some questions before choosing their EHR.

Don’t rush into buying EHR software that you are unfamiliar with. Make sure you understand how it will integrate with your organization.

Check what kind of training your software provider offers to ensure your staff can quickly get up to speed with the EHR system.

Verify the skill level and knowledge of your software company to make sure it will be capable of handling upgrades, especially those mandated by governmental regulations.

Does the EHR vendor provide the type of customer service that you deem appropriate? You will want to go with a firm that has excellent communication skills and will respond in a timely manner.

Changing electronic health record systems could improve EHR functionality and help physicians meet meaningful use requirements, but physicians might be unhappy with the switch, according to a survey published in the journal Family Practice Management, FierceEMR reports.

For the survey, researchers polled 305 family physicians who had switched EHR systems in 2010 or later. The survey was conducted between July 2014 and September 2014 (Edsall/Adler, Family Practice Management, January/February 2015).

Survey Findings

The survey found that the most common reasons for changing EHR systems were:

Needing additional functionality;

Wanting to meet meaningful use requirements;

Desire to increase usability; and

Requiring improved training and support.

Researchers also found that 59% of respondents agreed or strongly agreed that their new system had better functionality, and 57% said that the change helped them to meet meaningful use requirements.

However, just 43% of respondents indicated they were happy with the switch to a different EHR system. Respondents who were part of the decision to change EHR systems were happier with the change than those who were not part of the decision-making process.

Overall, 81% said the time investment in changing EHR systems was challenging, with issues such as:

Productivity loss;

Data loss; and

Data migration problems.

Comments

Researchers said that physicians need to carry out a careful evaluation of their current EHR system prior to making a change. They also said that making alterations in physician workflow could result in better outcomes.

They noted that switching EHR systems might be necessary to improve functionality or achieve meaningful use but added that "if you just want to change because you don't like using your current EHR or consider it a drag on your productivity, the grass may not be greener on the other side"

Amazing Charts, a leading developer of Electronic Health Record (EHR) systems for physician practices, today issued its healthcare predictions for 2015.

1. Membership Medicine Comes on Strong: The patient membership approach to medicine will grow in all forms, including value-based Direct Primary Care (DPC), high-end Concierge Medicine, and primary care services contracted directly by employers. Market-driven medicine, fueled by changes occurring in healthcare today, such as inexpensive health plans with very high deductibles, will continue to encourage consumers to explore more cost-effective alternatives for primary care.

2. Patients Help Define the Experience: The patient, in partnership with the provider, will help define the care experience going forward. This trend will be powered by technologies that enhance face-to-face interaction in the exam room. One example is the projection of an EHR onto a large display screen to facilitate information sharing between provider and patient. This in turn will help reduce errors and misdiagnosis, as well as motivate patients to take a renewed interest in their own healthcare and treatment options.

3. EHRs Get Personalized: The EHR market will further mature and become customizable for individual patient needs and treatment plans. Intuitive data analytics will play a critical role here, helping clinicians measure, assess and manage their specific patient populations to better define specific gaps in clinical care and introduce the latest evidenced-based treatment procedures or diagnostic techniques.

4. Wearable Health Devices Empower Patients: Led by FitBit, the market for mobile health monitoring devices saw explosive growth in 2014. Now Apple is entering the scene, and 2015 promises to see even more apps and devices introduced to consumers. How the government regulates these devices may depend on how they are marketed. For example, a glucometer could be unregulated if the intent is for a user to monitor blood sugar levels for better nutrition. If the same glucometer is marketed for monitoring diabetics, however, it may be more strictly regulated as a medical device.

5. EHR Interoperability Still Around the Corner: While all EHRs will not be able to seamlessly communicate in 2015, the core infrastructure for increased data liquidity will largely be in place. The data standards of the CCDA and its predecessor, the CCD, are increasingly used by EHR vendors. In addition, Meaningful Use Stage 2 mandates that patients can receive a digital summary of their own records on demand. These positive steps forward will combine in 2015 to get us closer to the promise of data interoperability.

6. EHR Switching Accelerates: Many practices selected an EHR system lured by the promise of Meaningful Use incentives and now find themselves dissatisfied with their decision, primarily because the solution is not user friendly and slows them down. Despite barriers to switching systems, we will witness a mass conversion of solutions toward EHRs that better meet providers’ expectations and requirements.

7. The Doctor Will NOT Be In: In 2015 and beyond we will see reimbursements drive the “virtual” appointment, whereby health plans will reimburse clinicians for online patient visits. Patients and their providers will connect over virtual platforms for scheduling, reviewing test results, writing prescriptions, etc. As they do, more and more insurers will follow suit as technology advances and claims its place in the doctor’s office.

There are a lot of reasons for healthcare professionals to dislike the notion of ICD-10. More mandates, more money, more work, and more complications that do nothing but take highly-trained physicians away from the business of patient care have been repeatedly cited as reasons why the industry should just forget the new code set all together. But new research from AHIMA shows that frustration, empty pockets, and exhaustion may not be the only things slowing down the ICD-10 adoption process. Many physicians in a series of focus groups expressed straight-up fear about how the new codes will impact their practices – and even more worryingly, expected their EHR vendors and billing services to do most of the heavy lifting as October 1, 2015 draws near.

“ICD-10 is scary for most people,” one physician admitted during one of the interview sessions. The large-scale changes required to bring clinical documentation up to the appropriate level of detail and specificity are of great concern to many physicians, not only due to necessary changes in their workflow, but also because of the uncertain impact on their reimbursement.

Physicians may be jittery about the unknowns of the future, but they aren’t necessarily being proactive about addressing them. Blaming a lack of simple educational tools, comprehensive resources, and specialty-specific guides to clinical documentation improvement (CDI), physicians in the focus groups are generally taking a wait-and-see approach to problems that may arise from documentation issues. They will address issues as they occur and learn as they go after implementation. They expect their EHR and billing system vendors to provide them with templates and order sets that will make documentation easier, and tend to think the biggest problems will only hit providers who perform a wide variety of procedures or see very complex patients.

“I have not done anything except read an article or two about how codes are going to increase in ICD-10,” a participant said. “I am relying on my billing service to do that. With respect to the hospital, they have not really given us any formal training for ICD-10 at all.”

“Physicians…typically don’t want to spend very much time on training for things like this,” added another. “It’s hard to engage them, so finding a set of materials that they will respond to positively would be valuable.” Hiring an HIM or CDI professional to develop educational programs and train physicians on ICD-10 issues seemed an attractive path for some physicians, but others worried that hospitals with the resources to maintain an HIM department may only invest in significant training for inpatient coding, leaving the less lucrative outpatient coding aside.

“Hospital coding is totally depending on ICD-9 and as they convert to 10, they will do the training (for inpatient). But that is inpatient. What about outpatient? The hospital will train you as they have a vested interest. For outpatient, I don’t know,” remarked a participant.

“For surgeons, nothing came from formal groups; most of the information regarding ICD-10 preparation and training would come from the hospital side as they have the best interest in training the physicians mainly for hospital utilization and reimbursement purposes,” agreed another.

Will EHR vendors and billing partners pick up the slack? Physicians certainly hoped so, believing that vendors would provide training and assistance if their hospitals and specialty associations didn’t give them adequate education. The groups called ICD-10 a “new language” for them to learn, and put specialty educational materials at the top of their wish lists. One requested “ICD-10 for dummies dumbed down by specialty,” while others asked for easy-to-understand crosswalks and a top-ten list of the most frequent reasons claims are being rejected.

The problem, many of the responses seem to indicate, is that ICD-10 isn’t meeting physicians where they are. CDI itself is not the issue, nor is the extra burden of added time and education, even if the thought of spending a few lunch breaks or extra evenings in a specificity seminar isn’t enticing. ICD-10 has taken on a life of its own as the big bad wolf of the healthcare industry, its shadow of trepidation growing deeper each time the new code set is delayed. Many physicians want to view the changes as a positive development, but feel that available resources aren’t helping them do so. “Articles on ICD-10 are fear-based,” said a participant. “I try not to go there.”

So where will they go? To health information management professionals, hopefully, or to CDI experts offering outsourcing services or workshop materials that will preempt the watch-and-wait attitude that may result in significant reimbursement disruptions. It isn’t fear mongering to say that preparing in advance for ICD-10 is a wiser course of action than simply hoping that the storm will pass by without serious damage, or letting fear of the unknown preclude the search for resources that will meet a specialist’s particular needs. ICD-10 will require effort, but the industry has been preparing for the switch for a long time, and the right training is available to those who look for it.

This summer the DOD is set to award the multi billion dollar electronic health records contract. Each group that bid on it contains at least one company the provides product and one with heavy weight Gov’t/DOD presence.

Who is going to win? Who is in real trouble if they don’t? As far as the winner is concerned, my new, Christmas gift , Crystal Ball doesn’t have this level of experience yet. What I do know is that who the actual winner is will affect the entire Healthcare IT marketplace.

Of the bidders, there are a few companies “betting the farm” on winning this. More later on who, but they could be in serious trouble if they are not the winners.

The contract is scheduled to be awarded in early July. I’m sure there will be protests and pressure from the losers, so the contract’s full impact might be delayed briefly.

When all this is sorted out the need for qualified people to work on the project is going to be huge and securing a position there will be considered a prize for many because the contract itself is going to last for at least 8 years.

Basically this means that if you are looking for a position, there are going to be a huge amount of health IT job opportunities available. As professionals move to the DOD contract, most will need previous experience. Where are they going to come from? These experienced professional departures will create job opportunities when they leave.

For employers, you might want to look into your employee retention efforts. Some companies out there are going to have a major problem with retention. You may be putting out fires all summer long as the experienced health IT marketplace shifts.

Say what you will about the pains of implementing an EHR or meeting the requirements for Meaningful Use. I’ll grant you that there are hiccups, roadblocks, stumbling points on the path to going digital. No doubt. But, you can’t deny that data doesn’t lie and when we measure data, we can manage it.

Case in point: an 11-doctor pulmonary group was scheduled to attest to Stage 2 Meaningful Use in 2014. The group’s practice manager was new to the organization and tasked with the responsibility of managing the eligible providers’ progress. She was overwhelmed and understandably nervous that the responsibility for earning $92,000 of incentive funds and avoiding a 2% penalty in 2016 was on her shoulders.

The Stage 2 requirements were a worry. The practice had just recently updated to the 2014 Edition EHR software and the patient portal had only been implemented for a month. She wasn’t sure if they could meet the patient engagement requirements and she didn’t know where they stood with the newly introduced objectives.

She asked for support through her network and found me.

Data > Information > Knowledge

I started by getting access to her EHR and venturing to the reporting module. I found out how each provider was performing on each of the Stage 2 Meaningful Use criteria and compiled the data. In fact, you can see their starting point for yourself by looking at the left side of the below chart. (Hint: click image for better viewing)

I could see right away why the practice manager was concerned. You can see on the left side that as of October 5, none of the providers were meeting the criteria for Core 7 (VDT), Core 12 (Patient Reminders), Core 17 (Secure Messaging), or Menu 4 (Family Health History). Only half of the providers were capturing enough vitals information (Core 4) and clearly workflows needed to be reinforced for several others, including Core 1 (CPOE for medication orders), Core 5 (Smoking Status), Menu 2 (Electronic Notes).

They were able to exclude Core 15 (Transition of Care), which is why those rows are blank.

We had 90 days to turn this around.

Team Work

Armed with information, we came up with a plan. The practice manager would work with each doctor and their support staff to communicate the goals, state their status, and ensure that each person was enrolled in doing their part.

Meaningful Use is a team sport, after all.

The nurses were charged with increasing their vitals stats. The administrators made sure that reminders were sent out to patients with a specific diagnosis for preventive or follow-up care. The doctors were instructed to collect smoking statuses for more patients.

We found out that there were new features within the EHR to accommodate Stage 2, so with help from the EHR vendor, we found out how to trigger the numerators for electronic notes and for family health history. It took a couple tweaks in customization and then training on the new workflows.

With each week’s reports, we saw steady improvement. But it was important to keep the pressure on to strengthen the areas of weakness.

Getting Creative with the Portal

In November, we focused diligently on the portal. The practice has several locations, so they started a contest among them to see which office could sign up the most patients to the portal. Some locations struggled more than others, complaining of elderly patients not having access to the internet.

Ultimately, what worked best was incentivizing the patients. They purchased a bunch of $5 gift cards to Amazon and gave them out to patients AFTER they had both logged in to the portal to view, download, or transmit their health record AND sent a secure message to the doctor.

They even told patients what to say:

Dear [Provider], I was able to see my health record through the portal. Now I know where I can send you messages directly if I have questions. Thanks, [Patient]

This step alone addressed the tougher patient engagement objectives and by mid-November, we started seeing drastic improvements in the VDT and Secure Messaging stats.

The First Big Win

Around the same time, we got the first provider to meet ALL of the percentage-based requirements. It took some targeted attention to improve specific workflows, but once the first doctor demonstrated that it could be done, the others followed right behind him. By the end of November, more than half the providers were hitting the marks; and by the second week of December, all of them were.

Their main focus on closing out the year was to keep up the good work.

Non-Percentage Based Objectives

Some Meaningful Use requirements are not numerator/denominator based and require a Yes/No response. For example, were clinical decision support rules in place and did at least 5 of them related to the chosen Clinical Quality measures? Did each provider generate a patient list for a specific diagnosis for the purpose of sending reminders, outreach, or research? Was a Security Risk Analysis performed and security updates implemented to correct any identified deficiencies? Yes, yes, and yes.

Lessons Learned

1. It sure helps to have engaged team members. The practice manager served as the messenger – communicating where improvements were needed. The doctors were responsive to looking at their data, comparing it with their peers, and then making concerted efforts to improve. The office staff were all willing to step up their game when they understood the mission of engaging patients. The EHR vendor was helpful with setting up the appropriate settings and customizing the EHR when needed.

2. What gets measured gets managed. Sticking our heads in the sand and hoping Meaningful Use would take care of itself simply would not have worked. We needed to know where improvements could be made and the only way to do that was to look at the data often and respond to it.

Physician offices continue to adopt EHR technology so why is meaningful use participation being ignored by these eligible providers?

Physician office EHR adoption continued its upward swing between 2013 and 2014, but less than half of physicians in a recent survey report plans to attest for Stage 2 Meaningful Use.

The last bit of news comes from a survey of nearly 2000 members of SERMO, the online social network for physicians. Frank Irving of Medical Practice Insiderreports that 55 percent of respondents will not demonstrate Stage 2 Meaningful Use in 2015, 994 of 1816 to participants.

Eligible professionals have until the end of next month — February 28 — to attest for meaningful use in 2014. According to the Centers for Medicare & Medicaid Services (CMS), more than 257,000 EPs are receiving 2015 Medicare payment adjustments for failing to demonstrate meaningful use as part of the Medicare EHR Incentive Program prior to 2014. That number is less close to 60,000 EPs who successfully filed for a meaningful use hardship exception during one of the two application periods in 2014. Those failing to demonstrate meaningful use in 2014 will be subject to Medicare payment adjustments in 2016.

It is unclear whether respondents to the SERMO survey are referencing their 2014 meaningful use reporting as the attestation period runs through the end of February 2015 or if they have chosen one of several options in a meaningful use flexibility rule or received a meaningful use hardship exception. That 55 percent could therefore prove misleading.

Continued growth of physician office EHR use

Whatever the reasons behind these responses from SERMO members, physician office EHR adoption is on the rise. An ongoing study by SK&A indicates a ten-percent increase in physician office adoption of EHR technology between 2013 and 2014. What’s more, it provides a breakdown of the top-five EHR vendors nationally and regionally.

At the national level, Epic Systems controls 30 percent of the market followed by eClinicialWorks (22%), Allscripts (19%), Practice Fusion (16%), and NextGen Healthcare (13%).

A closer look by region shows a close competition between Epic Systems and eClinicalWorks for EHR selection by physician offices.

The former dominates the West, Midwest, and East regions of the United States. The latter holds sway in the South and New England regions. Here’s a region-by-region breakdown:

Interestingly, where neither is first both companies drop to the third or fourth spots. Considering that both companies specialize in working with health systems and hospitals, their domination of various markets may indicate the ownership of physician practices and use of that health system’s or hospital’s EHR technology.

Despite the increased implementation and use of EHR technology by physician offices, their physicians have a ways to go in order to keep pace with the evolution of the EHR Incentive Programs.

It's more of a requisite first step than milestone, but the Department of Health and Human Services sent the proposed rule for meaningful use Stage 3 to the Office of Management and Budget.

There’s precious little detail in these submissions, but HHS foreshadowed the major problems it intends to address with this next, and perhaps final, stage of the federal EHR Incentive Program.

"Stage 3 will focus on improving health care outcomes and further advance interoperability," according to OMB’s website. "Stage 3 will also propose changes to the reporting period, timelines and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements."

The Office of the National Coordinator for Health IT also submitted a rule to OMB proposing a new 2015 Edition Base EHR definition, as well as modifications to the ONC Health IT Certification Program, "to make it more broadly applicable to other types of health IT health care settings and programs," another OMB web page states.

ONC’s proposed rule would establish capabilities and criteria, and specify standards and implementation specifications that EHR makers must meet, to "at a minimum support the achievement of meaningful use" for customers including eligible hospitals and eligible providers looking to attest and receive incentives.

OMB ranks both proposed rules as “major” but the in the form’s legal deadline field the status is none.

Physicians and their staff also need to be able to review, transmit, reconcile, approve, and synthesize all of that clinical information to help make better, more informed decisions with their patients.

In 2008, fewer than 1 in 10 physicians were using an EHR, and the functionality that existed in those systems then would not qualify as a federally certified EHR product now. Over the last decade, to achieve federal certification, vendors worked at a feverish pace to add hundreds of features and change dozens more in order to achieve parity with the rest of the market. This transition from paper to digital happened so rapidly that usability suffered, innovation lagged, and real customer needs were under-prioritized.

Now that all certified EHRs share minimum functionality and can exchange information with each other, the time has come to refocus this entire industry on improving customer satisfaction.

The Office of the National Coordinator for Health IT has attempted to regulate the design of EHRs in a way that has not resulted in broad usability improvements to date. Approaching this immense problem from a more prescriptive regulatory perspective barely scratches the surface of what customers are demanding. While there should be required minimum standards for any software that is utilized by medical professionals to help them manage something as critical as patient health, no regulatory framework for usability will lead to more delightful user experiences for medical professionals or their patients.

What technology is needed in a modern medical practice?Most complaints from EHR users stem from the feeling that the computer interferes with the ability of physicians to provide great, human-centered care for their patients. Many user interfaces look like they are 10 to 15 years old (because they are) and fail to meet customer expectations for how a modern application should function. Alert fatigue, infrequent software upgrades, and inefficient workflows contribute to this general dissatisfaction. In a recent study, researchers found that physicians spend 3 times the amount of time with computers as they do with their patients during a typical day. It's no wonder that EHR usability is consistently rated poorly across most software vendors.

Physicians and their staffs ultimately need software that supports their practice throughout the entire patient journey. Technology vendors must completely rethink their offerings by applying the essential components of user-centered design that have worked well in other industries.

Implementing an intentional approach to usable softwareUsable software applications are intuitive, easy to learn, and memorable. They also must be efficient and prevent errors, all while deeply satisfying their users.

To achieve these six goals in health software, vendors must first gain a deep understanding of how a physician's office works – from the beginning of the day until the lights are turned off. A team of user researchers dedicated to this scientific task, investigating directly in doctors' offices, is crucial.

Tip: Merely dropping in for a few hours of office time is insufficient.

Shifting to a user-centric approach in EHR design also requires gathering as much information as possible about how technology can assist customers with common tasks and data-intensive decisions.

Tip: It helps immensely to have a central place on the web where customers can request features. Often, the conversation that occurs in the comments section is crucial for software development teams to smartly refine feature requirements and improve usability.

Executives of EHR companies must embrace and encourage iterative software development within their product and engineering teams, with customer feedback directly informing each iteration.

Tip: Pair "minimum viable product" software development methodologies with user experience personas to turn users into happy evangelizers of products they love using every day.

Achieving indispensable EHR technologyFor decades, physicians have pleaded with software makers to build functionality that helps them make better treatment decisions and provide better care for their patients. EHR vendors have instead delivered technology that is minimally usable and slows down the practice of medicine. Fortunately, this is not how it has to be.

As the entire healthcare industry transitions its business model from fee-for-service to value-based care, modern medical practices will find themselves relying even more on healthcare technology that efficiently collects, reports on, and synthesizes clinical data. To truly capitalize on this opportunity for smarter decision-making that leads to improved patient outcomes, current basic EHRs must evolve into mature, highly usable, indispensable tools that physicians and their staff enjoy using.

There are many parallels between the enterprise database sector and EHRs. Can the evolution of this database industry guide progress in the EHR front? I think there are a number of similarities and solutions which can address the proposed problems facing EHRs and the global healthcare system.

Oracle, the first commercially available database system, has been in existence for more than 35 years. As a company, Oracle has encountered numerous competitive, technologic and economic challenges forcing it to re-think, re-engineer and re-develop its platform while maintaining backward access to huge volumes of data for its customers. Many enterprise database companies have since entered the marketplace, all bringing a unique and proprietary set of options, designs and performance.

Despite these differences, enterprise database systems, along with open source and the relatively new NoSQL databases are able to interoperate to meet the demands of customers who are dependent on reliable, scalable, high performing, usable and secure access to data.

Dr. Donald Voltz

Hospital EHRs are babies when compared to enterprise database systems, but they share a great deal of similarities and have become a central player in our healthcare system. Physicians, patients and other healthcare providers are becoming dependent on EHRs for the daily management of patients. Meanwhile, administrators, insurers and regulatory bodies have been developing policies, process and practices to using EHR data for population health, patient engagement and development of best practices at a systems level.

With the development of large scale, high performance ways to store and access increasingly larger data sets, enterprise applications have evolved to utilize the changing functionality with a commensurate understanding of customer demands leading to increased database functionality.

A cycle of sorts advanced the capabilities and allowed for the migration of application-centric software applications which were slow to change due to interdependencies. Looming was the real possibility of losing business critical functionality during upgrades to software as a service models (Saas) allowing for better scalability, more frequent software updates and higher reliability with lower overall costs.

The history of enterprise databases, and that of other enterprise software, shared similar criticisms as technologic advances occurred. The integration of legacy systems with evolving technology presented the greatest barrier to adoption, even when validated claims of higher performance, increased functionality, and lower costs were realized. These same criticisms have been voiced for EHR technology and are not likely to quite any time soon.

The problem of integrating new and old technology or bringing technology into an area traditionally administered by manual, static and labor intensive means, boils down to the misapplication and misunderstanding of prior solutions. In enterprise database applications and others, middleware integration architecture was introduced, but was slow to fix these challenges.

Middleware was dispelled and slow to be applied to the enterprise software problem, stemming from attempting to solve integration problems of evolving technology with middleware platforms built upon prior technology.

EHR interoperability in the early state of implementation and development does not have the legacy middleware problem since nothing existed before. In light of health information exchanges, proposals to develop data sharing standards, little has been presented on the middleware as a viable solution to the interoperability problem in healthcare. Although early in the implementation of EHR’s, they have made a large splash in healthcare and will be required to quickly scale to the available technology, including mobile. Medicine is many years behind other fields in the deployment of enterprise software solutions to meet the needs of hospitals and patients.

Oracle recently announced the release of a node.js database driver. This is yet another example of how large, proprietary enterprise software understands the need to implement middleware access so other innovative and motivated companies can develop new solutions to business, personal and social needs.

As we look forward, patient engagement with their health data, insurance, medical decisions and access to healthcare providers will necessitate additional development onto existing and emerging technologies. If healthcare follows the trends of other enterprise software, and there is no reason to suggest it will not, middleware has been the only architectural pattern to solve the integration problem in a cost effective way while supporting scaling, security and reliability of critical business operations.

83 percent of physicians expressed frustration using EHRs to support clinical communications due to poor EHR interoperability, limited EHR messaging capabilities and poor usability that makes it difficult to find relevant clinical data, according to a recent study by Spyglass Consulting Group. The report entitled Point of Care Communications for Physicians 2014 based on 100 doctors working in hospital‐based and ambulatory environments nationwide reveals physicians are universally (96 percent) using smartphones as their primary device to support clinical communications.Physicians Face Obstacles to Support Collaborative Care

Despite the universal smartphone adoption, the report finds 70 percent of physicians believe hospital IT organizations are making inadequate investments to address physician mobile computing and communication requirements at point of care due to limited planned investments, poor mobile EHR tools, and inadequate mobile user support. Majority of physicians interviewed report that they lacked the financial incentives, tools, and processes to support collaborative team‐based care. According to the Ponemon Institute, inefficient communications during critical clinical workflows costs the average U.S. hospital approximately $1.75 million annually. Former CMIO Shares His Experiences

Steven Davidson, MD, MBA former CMIO at Maimonides Medical Center, Brooklyn, NY whose last project at Maimonides improving physician communication comments, “As we were developing our plans for improving communication among clinicians, we discovered that few hospitals were investing in communication‐driven workflow support, perhaps because meaningful use and HIPAA are consuming all the resources. Still, it seems many IT leaders hope the EHR‐‐a tool poorly suited to the task‐‐will suffice. In reality, overwhelmed nurses and doctors struggle accomplishing necessary communication through the EHR; instead implementing workarounds on their own devices.”

Next Generation Communications

The report states that hospital IT has an imperative need to evaluate mobile devices and unified communications solutions to support collaborative team-based care and address regulatory requirements introduced by the Affordable Care Act including readmissions penalties, patient centered care models, and pay for performance. Spyglass notes that the next generation communications solutions must be secure, easy-to-use, and tightly integrated with the EHR to provide adequate clinical context to successfully close the communications loop with colleagues and team members.

In the rapidly-evolving EHR market, one size definitely does not fit all and true EHR customization can make all the difference.

It is a commonly-held belief that the healthcare system in the United States is in need of more than a fairly steep overhaul. In fact, the once highly sought after profession of doctor has shifted to become one of the more embattled jobs nationwide.

Many healthcare professionals are now forced into the impossible situation of navigating exploitation by insurance companies and government regulations, all while grappling with the challenges of providing quality patient care, keeping their practices afloat, earning a living and paying back often-exorbitant medical school loans. If anything, in today’s world it would surprise most people to know how little doctors actually make, relative to the effort and investment in their careers they are required to put in, day in and day out.

This is a critical issue facing the US today, as tens of thousands of physicians are closing their practices every year and either retiring or becoming employees of large healthcare corporations. This is having a significant impact on accessibility and affordability of medical care. With fewer doctors available and many individuals seeking care from “corporatized” healthcare providers, not only is the personal relationship between doctor and patient lost, the cost of medical care at corporate-run medical facilities is substantially higher than ever before.

Capable and cost-effective?

So, the question becomes — how do doctors maximize their healthcare practice and record management processes, cost-efficiently and effectively? Enter the wide variety of EHR and EMR solutions that have flooded the market in recent years, each promising to streamline the process and take the guesswork out of compliance to the government’s evolving mandates that regulate healthcare record-keeping.

In addition to managing healthcare records, doctors also need a secure and HIPAA compliant scheduling system, medical devices integration, practice management system, e-prescription, lab interfaces, patient engagement, and tele-medicine. Of course, these systems must also be equipped with disaster recovery and business continuity safeguards.

And while there are many current solutions on the market which range from open source to a one-stop package that practices implement directly on their end, they miss one crucial element. Each doctor practices his/her profession in their own unique way,and this extends to all aspects of their work, from patient care to record keeping and practice management. Just as Dr. Lawrence ‘Rusty’ Hofmann in The Huffington Post,describes it, “EHRs are like Model T Ford: Any Color You Want As Long As It’s Black.” The majority of these solutions hitting the market today just don’t cut the mustard when it comes to really addressing the needs of our country’s doctors and healthcare practices.

Furthermore, while the creators of many of these packaged EHR solutions claim to be “customizable,” they are actually merely “configurable.” Instead of allowing the user the autonomy and flexibility to create a system with parameters that align with their own specific practice and its operational goals, editable functions are typically limited to creating additional fields in the forms — barely paying lip service to the task of meeting the true needs of healthcare professionals in this country.

These solutions also require heavy reliance on a computer screen, which often hinders a doctor’s ability to provide the standard of care and bedside manner that comes with more face-to-face interactions inquiring into pain, ailments, and body language from patients. This seminal aspect of the healthcare field is threatened by one-size-fits-all systems that squelch the nuances between practices and the differing techniques doctors use to treat their patients. This diversity between providers is central to continued advancements in the medical field and breakthroughs in patient care and disease treatment.

Diversity and true EHR customization rule

So then, what is the answer? In my opinion, built from countless conversations with doctors on this issue, it is EHR systems that provide an easy-to-use interface that are truly customized to fit the ways in which each doctor treats patients, approaches his/her field, and manages their practice, in a cost-effective package that does not require a huge up-front investment. Additionally, everyone within the practice should have access to the system, to ensure continuity in an often-volatile EHR market that typically sees 45-50% churn annually.

In short, it is crucial that developers of these software tools accommodate doctors’ needs first, rather than create a framework that expects doctors to squeeze themselves into a pre-defined structure, often asking them to sacrifice their individuality, professional approach, and expertise.

This approach, which represents incredible opportunity in the once thought to be saturated EHR market, is the essential step to rescuing our doctors from their often embattled position, bringing them back to the esteemed position they once held, all while improving our overall patient experiences and outcomes in the process.

There are a lot of myths, misconceptions and fears about functional limitation reporting. The bottom line is that clinicians who see Medicare patients after July 1, 2015 must use functional limitation codes on their documentation for the initial evaluation, at least once every 10 visits, and at the time of discharge or they won’t get paid.

All practitioners need is an EMR system that prompts them to select one of the functional limitation measures and the goal codes at the appropriate time. It’s then a simple matter of sending the claim to the clearinghouse and on to Medicare for approval and payment. Functional limitation reporting is essentially a goal-oriented process.

Clinical Judgment

The judgment of the physical therapist is critical in meeting functional limitation reporting requirements. Therapists will need to document the patient’s condition at the initial visit, the selected treatment plan, severity of the client’s limitation and the expected outcome when therapy is completed.

In Touch EMR™ provides clinicians with prompts for all the information, G-codes and modifiers needed and at the appropriate times to remain within compliance. The data automatically goes into the patient file for transmission.

Supporting Evidence

Documentation to support every decision, measure taken and treatment is critical. Therapists must maintain a record of the patient’s level of function upon their initial visit using their best clinical judgment, combined with the information obtained from the patient.

Listen closely to what the client says and observe their range of movement to accurately select the level of severity under which they’re functioning. Meticulous records are necessary to document the condition of the patient at each treatment session and when the patient is discharged from further therapy. The process begins again if further treatment is required.

The EMR clinicians choose should have the ability to prompt them at the three major checkpoints of functional limitation reporting – initial evaluation, the 10th visit, and at discharge. In Touch EMR™ provides practitioners with that functionality, making it easy to remain in compliance and get paid.

Mayo Clinic announced this week that it would be abandoning its three current EHR systems in favor of a new contract with EHR giant Epic, which will now be the healthcare icon's sole EHR provider and strategic partner, according to a Mayo press release.

The plan is to deploy a single, integrated Epic EHR and revenue cycle management system at Mayo's main campus. Jilted in the deal are GE and Cerner, who were the providers of Mayo's current systems.

"With our staff working together on a common system, we will be able to accelerate innovation, enhance services and provide a better experience for our patients," said Dawn Milliner, MD, Mayo's chief medical information officer, in the release. The current schedule will see the project team assembled by April of this year, with the actual system being built between then and 2016, and a final implementation target of 2017.

Dive Insight:

If this were any other press release from almost any other provider and vendor, it would not be news. But the words "Mayo" and "Epic" make this an important milestone in an incredibly competitive race.

First, it's a game changer for the Mayo Clinic, as it will completely overhaul its existing system from scratch. Moreover, it's a bodyblow to Cerner,who we predictedhad a good shot at swiping the top spot in the EHR biz from Epic earlier this year. We'll be the first to admit this is a big win for Epic, and while it's not big enough to put Cerner down for the count, it's a good way for Epic to start the year (and not so good for Cerner).

Now that Congress has rejected requests to delay ICD-10, it’s time to get on the bandwagon or risk significant financial implications. ICD-10 touches virtually every aspect of your organization’s processes and systems, and failure to prepare and comply with the mandate will have a significant impact on your reimbursements.

If your organization has lost momentum or has not started the ICD-10 journey, hiring internal resources or working with external experts will be necessary to meet the deadline. Below is a cheat sheet – based on best practices and industry guidelines – of essential questions to ask leadership and next steps:

Is ICD-10 a priority for your leadership team?Evaluate organizational awareness of ICD-10 and confirm leadership is in place to drive the transition. Successful ICD-10 planning involves defining project leadership, executive sponsorship, and reporting structures. Given the far-reaching organizational impacts of ICD-10, without defined roles and responsibilities, a critical remediation area may be missed. Identify stakeholder accountability for ICD-10 compliance and designate project managers to lead revenue cycle, coding and clinical documentation improvement (CDI), and IT system initiatives. Develop a project communication plan that sets expectations about what should be communicated to whom, the reason for the communication, frequency, and method.

Are your systems ready and have you evaluated the impact of ICD-10 to all system workflows?Assess operational readiness by taking an enterprise-wide systems and process inventory to identify where codes are used. Utilize assigned project managers to uncover all systems and processes where ICD-9 codes are sent, received, or stored. Conduct workflow analyses to ensure understanding of how systems and processes are impacted. This exercise can provide immediate benefit to an organization as workflows operating inefficiently are identified. Develop a prioritized project plan and remediation timeline for each impacted area. For example, technology and workflows need to be optimized within patient access to assure compliant orders for dates of service on or after October 1, 2015. Conduct regular reporting on initiatives and ensure stakeholders are being held accountable for designated tasks.

Does your staff have appropriate organizational awareness and knowledge of ICD-10?Understand what roles individuals play within your organization with respect to ICD-9 code usage, and employ a role-based training initiative. While coders, CDI specialists, and providers will need the majority of training, areas, such as patient access, ancillary departments, business offices, and IT should not be overlooked. Also, keep in mind the impact on your quality team. Patient populations monitored by core measures, as well as other quality metrics are determined by ICD-9 codes. When selecting a training vendor, confirm the vendor offers courses tailored by job function and provides the necessary courses for coders and specialty-specific training for providers. Track and communicate training progress and ensure training compliance is an organizational priority. As part of your strategy, attempt to incorporate training with other planned education to reduce workflow disruption.

Are you establishing ongoing experience with the new code set?Act fast to incorporate dual coding initiatives. Based on experiences with ICD-10 in other countries, research suggests that allowing coders to simultaneously code in ICD-9 and ICD-10 allows them to achieve proficiency and decrease productivity loss. Dual coding has been shown to significantly reduce the anticipated 40 to 60 percent inpatient and estimated 20 percent outpatient productivity loss. The first step is to create a project plan that identifies coders, checks systems, and determines expected coding system upgrades. Next, create a strategy for managing dual coded data to be analyzed. A coding roundtable of key stakeholders from an organization’s coding team should be developed to create accountability and drive documentation improvements during the dual coding process. As part of the learning process, coder education should initially emphasize documentation requirements for coding the most common conditions within the organization and those with the highest allowed amounts. A minimum of six months of practice is recommended.

Are you conducting internal and external testing of systems for ICD-10 compliance?Define testing goals and document a plan to test each impacted system internally and conduct external testing to the greatest extent possible. Appropriately testing impacted applications is a complex and time-consuming process and should not be seen as a last step. Many variables — including competing organizational priorities and resource availability — as well as clearinghouse, payer, and third-party tester schedules, can influence the testing timeline. Designate a well-defined team to undertake, define, and monitor the testing readiness plan for your impacted systems and software. Each impacted system should be reviewed for the type of testing that is needed. Billing systems are the most complex and must be ready to send ICD-10 coded bills to payers or payment will be denied. Testing of billing systems should include all of the workflows where codes live, (e.g., claim edits that currently contain ICD-9 codes). Use your high volume and high value codes for testing, and determine the ICD-10 workflow for each impacted application. Then, complete individual testing of applications by running the applications through the identified workflows. Once that process is complete, begin integrated testing through following the process for codes to flow to downstream applications and out to the payer. If you haven’t been selected for payer testing, then work with your clearinghouse to test claims externally through them.

Is your CDI program optimized and ready for ICD-10?Emphasize clinical documentation process improvements to realize bottom-line gains now while preparing for ICD-10. While most healthcare systems have a CDI program, many are not achieving the desired results in appropriately coding conditions to the highest level of specificity. For example, if the organization is not able to code the specific type of congestive heart failure in ICD-9, the problem will only worsen in ICD-10 with requirements for greater specificity to attain complications and co-morbidities (CCs) and major complications and co-morbidities (MCCs) for many DRGs. While revamping a CDI program is a separate goal, perfecting ICD-9 queries and introducing ICD-10 queries early will help prepare an organization for ensuring compliance with the increased specificity ICD-10 demands.

Have you planned for predicted delays in cash flow?Create a contingency plan to mitigate potential productivity and revenue losses. Hope for the best, but prepare for the worst. Based on Canada’s ICD-10 experience, coding productivity may drop by 50 percent immediately following implementation. Performance improvements may take at least 90 days to be realized. If claims are suspended, rejected, or delayed following ICD-10 implementation, have a plan available in advance to quickly respond to different scenarios. Alternatively, some providers and payers have drafted stopgap provisions in their contracts to maintain a consistent cash flow and “true up” every three months.

While changing processes, systems, technologies, and staff resources to accommodate the shift from ICD-9’s 17,000 to ICD-10’s 140,000 codes may seem overwhelming, there is still time to meet the requirements by taking a prioritized and focused approach. Having the right mix of expertise and staffing is necessary to meet the upcoming deadline. Contingency plans will also help mitigate losses following ICD-10 implementation. Beyond getting paid, ICD-10 also promises to improve clinical outcomes by increasing the specificity and accuracy of clinical documentation to guide patient care decision-making. It’s an investment that is worth the effort.

The industry news is full of disparaging talk about the health of the EHR Incentive Programs (i.e., meaningful use), particularly the low number of Stage 2 attestations. While some statistics show that only 35% of the nation’s hospitals have met Stage 2 meaningful use requirements, further analysis reveals a different story.

Each month since July 2014, CMS and the Office of the National Coordinator for Health IT update the Health IT Policy Committee on the number of successful Stage 2 attestations. The following day, the same headlines appear with multiple industry analyses and strong reactions that take the low attestation volume as a sign of failing long-term meaningful use viability. These critics say that in November 2014, only 17% of the nation’s hospitals successfully demonstrated Stage 2, and most recently that in December 2014 that figure was 35%.

These numbers are being used to demonstrate how difficult it is for the majority of the hospitals to meet Stage 2 requirements and even to make the case that most will not be capable of attesting due to overly stringent requirements. While these numbers are not technically wrong, a closer look reveals a different picture. This is not an attempt to be provocative, but rather we want to provide additional detail to those figures because they do not tell the whole truth about how well hospitals have fared in Stage 2.

Stage 2 Attestation Numbers Send Mixed Messages First, the numbers cited were correct when the number of Stage 2 attestations were compared with the entire population of U.S. eligible hospitals (EHs). Of course, based on such data, it looks as if only about a third of the hospitals have been able to meet Stage 2 requirements through the end of November 2014. Some have interpreted this number to mean that meaningful use Stage 2 is a disastrous program, but the industry should not use these numbers to judge the success of Stage 2, or in fact, hospitals’ ability to meet the requirements. Why?

The EHs participating in the EHR Incentive Program are required to progress through a set meaningful use timeline. This means every meaningful use participant is scheduled to start at Stage 1 and remain in each stage for two years before moving to the next stage, unless the policy allows otherwise. For example, the early adopters who began in 2011 were in Stage 1 for three years instead of two, as CMS moved the Stage 2 start year to 2014. Therefore, not every EH in the nation is scheduled to attest to Stage 2 in 2014. Even if they wanted to attest to Stage 2, they would not be able to do so.

Instead, the industry should look at how many EHs are scheduled to be in Stage 2 in 2014, rather than looking at all EHs. Per the CMS data:

809 hospitals attested to Stage 1 Year 1 in 2011;

1,754 hospitals attested in 2012;

1,389 attested in 2013; and

83 attested in 2014 by Sept. 30.

Thus, only 2,563 hospitals (i.e., those that started in 2011 or 2012, or 809 + 1754) were scheduled to demonstrate Stage 2 in 2014. Among these hospitals, 65.58% (1,681) of EHs successfully attested to Stage 2 by Dec. 1, 2014. It is this number that tells an accurate story of Stage 2’s viability so far.

Admittedly, CMS only includes Medicare-only or dually-eligible EHs in the database cited above, and CMS did not clearly indicate whether 1,681 include all types of EHs. However, the number of Medicaid-only EHs account for a small proportion here. Based on CMS’ October 2014 report, fewer than 100 Medicaid-only EHs should be in Stage 2 in 2014. Even if we added 100 to the calculation to account for Medicaid-only EHs, the percentage would still be at more than 63%.

Attestations Are on the Rise In addition, the number of successful Stage 2 attestations has grown exponentially since CMS first announced that 10 hospitals attested to Stage 2 by July 1, 2014. We find many organizations wait until the final 30 days or even closer to the attestation deadline to attest, so it is no surprise to see such growth — especially in the last few months when the number doubled between Nov. 1, 2014, and Dec. 1, 2014.

Additionally, the majority of EHs had to wait until Oct. 1 if they chose the last fiscal quarter, as is likely the case for the majority of attestations. This approach was popular because it gave these organizations the first three quarters of the fiscal year to implement the 2014 Edition CEHRT and to make the required workflow adjustments. So the nearly-66% of successful Stage 2 EHs attestation will only rise from here, especially considering the fact that CMS has extended the hospital attestation deadline to Dec. 31.

Where Hospitals Stand at the End of 2014 The College of Healthcare Information Management Executives recently estimated that about one-third of the hospitals scheduled to attest to Stage 2 in 2014 will use the flexibility rule, which allows them to attest to Stage 1 requirements in 2014 if their certified EHR upgrade was delayed or unable to be implemented at all. If we combine the numbers of those who successfully attested to Stage 2 and those who will rely on the flexibility rule, more than 95% of hospitals are able to attest in 2014. Again, that percentage does not look like a disaster; it shows that the tremendous efforts these hospitals put toward readying themselves for Stage 2 in 2014 paid off for more than half, and CMS’ lifeline worked.

Taking the same approach for eligible professionals (EPs), 57,595 and 139,299 of Medicare EPs attested to Stage 1 Year 1 in 2011 and 2012, respectively. This means 196,894 EPs are supposed to be in Stage 2 in 2014. Per CMS data, 16,455 EPs successfully attested to Stage 2 by Dec. 1, 2014, which accounts for an 8.36% success rate for that group. Of course, the number appears low at this juncture. However, based on the trend for EHs, we expect the numbers to grow tremendously as the majority of the EPs would also rely on the last calendar quarter as their reporting period (Oct. 1, 2014, to Dec. 31, 2014), and EPs can complete their 2014 attestation within the first two months in 2015. In short, it is too early to draw conclusions regarding EP attestations. The real story still remains to unfold for the EP Stage 2 attestation.

Many have touted the misleading data and message that meaningful use is a failure as a reason to push CMS to reduce the reporting period in 2015 from one full year to one three-month quarter or 90 days. We agree with the many benefits that a shortened reporting period in 2015 would provide, and we offer an alternate rationale based on our analysis of the data.

First, so far, about two-thirds of EHs that are scheduled to be in Stage 2 in 2014 have successfully met the requirements. Based on research conducted among our members, we found that the shortened reporting period in 2014 played a critical role in their success. They would not have been able to attest or found it to be significantly challenging if any longer than a three-month quarter reporting period were imposed in 2014. This is because they would not have sufficient time to completely implement and stabilize the 2014 Edition CEHRT and to adjust existing or implement new workflows. In addition, the longer reporting period would equate a higher denominator, making it more difficult or nearly impossible for the providers to achieve the required threshold.

Stage 2 also introduced more complex objectives such as View, Download and Transmit, and Transitions of Care. These two objectives alone required many hospitals to deploy their IT capabilities in new territories of patient engagement and information exchange. As we’ve previously discussed, these two objectives are arguably the most challenging in Stage 2, and the majority of providers who attested showed marginal performance around the required thresholds. These two objectives are significant first steps toward something greater in health care, and it will take time to improve performance in these areas. CMS recognized these challenges and enacted the flexibility rule in 2014. It certainly would not hurt the forward momentum of the meaningful use programs to allow such an option in 2015.

Second, the meaningful use program is not just about what providers can or should do. It is about all of us. We all need to keep in mind that the ultimate goal of the meaningful use program is to promote better care and better health for consumers/patients, including ourselves.

Per a recent report, patients value providers’ use of EHRs, appreciate the ability to access their data in a timely manner and seek even more robust functionalities in EHRs. So far, one of the great accomplishments of the meaningful use program is the significant growth of EHR adoption among providers. This leads to higher recognition of its values among consumers. The meaningful use program should continue, but at a more measured pace, so we all can achieve the goal with little to no compromises.

We hope that these numbers and rationales provide a meaningful perspective as CMS and ONC continue to make data-driven decisions in setting the policy in 2015 and Stage 3. We think that when one asks for leniency, showing great results so far and good faith based on accurate data would trump defensive arguments.

Nevertheless, while there is no further change in the existing policy, providers should continue to keep up their efforts and push to achieve the higher goal of better care and better health.

United States District Judge Otis D. Wright, II, concludes that the MyMedicalRecords ’466 in patent ineligible on the grounds that it pertains to “long-known abstract idea.”

Following the application of a test from a related patent case (Mayo Collaborative Servs. v. Prometheus Labs., Inc.), Wright takes particular umbrage with the eighth claim of the MyMedicalRecords complaint because it lacks “inventive concepts”:

Claim 8 recites a method for providing a user with the ability to access and collect personal health records in a secure and private manner by: (1) associating access information with the user to access a server storing files; (2) providing a user interface; (3) receiving files at the server from a health care provider; (4) receiving requests through the user interface; (5) sending files; and (6) independently maintaining files on the server. All six of these concepts are routine, conventional functions of a computer and server and therefore broadly and generically claim the use of a computer and Internet to perform the abstract purpose of the asserted claims.

According to Wright, the remaining claims similarly fail in adding anything of significance to the abstract idea of securing and sharing information.

Ultimately, the US District Court of the Central District of California sided with the defendants and their granted their motion judgment “without leave to amend.” For its part, MyMedicalRecords is still boasting a large patent portfolio that remains unaffected by the court order.

“MyMedicalRecords, Inc. will continue to pursue opportunities to monetize its 13 U.S. patents with more than 300 existing claims where appropriate in the burgeoning health information technology marketplace,” the company said in a public statement following the ruling.

As Adi Kamdar of EFF reports, the litigation being pursued by MyMedicalRecords works against meaningful use requirements that demand eligible providers perform each one of the activities listed by Wright.

“It falls in the category of threats from patent holders who decide to go after companies for abiding by new rules or regulations—doing so, they allege, infringes one or more of their patents,” he writes.

Without EHR technology certified to support, these providers would have limited options for selection EHR and health IT systems. For those opposed to “patent trolling,” the case of MyMedicalRecords raises questions about the patent application and acceptance process.

Why do these things always seem to happen late on Friday afternoons? At least this time it’s not right before a holiday. Actually, with a bit more inspection, I see that it did happen right before a holiday.

HIMSS is reporting today that the White House’s Office of Management and Budget is “in its final stages of review” of the proposed rules for Stage 3 of the Meaningful Use EHR incentive program. OMB always goes over proposed and final regulations to measure the fiscal — and, presumably, political — impact before allowing executive-branch agencies to make public releases.

A peek at OMB’s reginfo.gov site indicates that the MU Stage 3 proposal from CMS and related ONC plan for certification of EHRs are indeed at OMB for final review.

“We are proposing the Stage 3 criteria that [eligible professionals], eligible hospitals, and [Critical Access Hospitals] must meet in order to successfully demonstrate meaningful use under the Medicare and Medicaid EHR Incentive Programs, focusing on advanced use of EHR technology to promote improved outcomes for patients. Stage 3 will also propose changes to the reporting period, timelines, and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements,” CMS states in a rule summary on the OMB site.

In this recent Nextgov article, they talk about what Team IBM/Epic are doing to prepare for the massive bid:

On Wednesday, IBM and Epic raised the bar in their bidding strategy, announcing the formation of an advisory group of leading experts in large, successful EHR integrations to advise the companies on how to manage the overhaul — if they should win the contract, of course.

The advisory group’s creation was included as part of IBM and Epic’s bid package, according to Andy Maner, managing partner for IBM’s federal practice.

In a press briefing at IBM’s Washington, D.C., offices, Maner emphasized the importance of soliciting advice and insight from the group. Members of the advisory board include health care organizations, such as the American Medical Informatics Association, Duke University Health System and School of Medicine, Mercy Health, Sentara Healthcare and the Yale-New Haven Hospital.

Epic President Carl Dvorak explained the early move will also help test the performance of an Epic system on a data center and network that meets Defense Information Systems Agency guidelines for security. An IBM spokesperson told FCW that testing on the Epic system has been ongoing since November 2014.

As we noted in our last article, 2015’s going to be an exciting year for EHR as this $11+ billion EHR contract gets handed out. What do you think of Team IBM/Epic’s chances?

A new survey of physicians by Healthcare IT News' sister site finds that 55 percent of them won't attest to Stage 2 meaningful use this year. It's "almost impossible" says one specialist polled by Medical Practice Insider.

"The following sentence is false 100 percent of the time: 'We completed meaningful use stages 1 and 2 and as a consequence the care we provide for our patients has improved,'" said another skeptical doc – one of nearly 2,000 polled by MPI in partnership with SERMO.

There are plenty of reasons that physicians find it preferable to forgo this next, much-harder stage of meaningful use. For many, it just doesn't make sense for their practice – or for their patients.

"It requires patients to have emails and engage my EHR," said a cardiologist. "Well, I have a lot of patients in their 80s and 90s, and they don’t have computers, let alone email."

"My patients are reluctant to use messaging and I personally do not like the interface for my portal," said a family practitioner.

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